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17C-275 (3) a 'fl Z; 7_0 � 0') r, ••= CY) 71 Zpm cn O �. a Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. s,� Alterations NORTHAMPTON, MASS. 19 Additions APPLICAT N FOR PERMIT TO ALTER Repair Garage e 1. Location Lot No. 2. Owner's name 6 Address 3. Builder's name Address Mass.Construction Supervisor's License No. Expiration Da e 4. Addition 5. Alteration 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire 9. Garage No.of cars Size 10. Method of heating 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cost:- The undersigned certifies that the above statements are"e to the best of his, her knowledge and belief. $igna'ture of respo si !e app,ican! Remarks °' <L O$ 3 199 Grif-R of 'Hart amptou Jlassrtchnsetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' O�y SV, Northampton, Mass. 01060 RIKER'S C'/ SATTON INSURANCE AFFIDAVIT I, (license&permittee) with a principal place of business/residence at: (phone#) 77/- �/-G-37X (-&=Ucity/ 2ip) do hereby certify, under e pains and penalties of pedJury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following workel's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attam additional sheet ifnecenary to include information pertaining to all ooatrac o ) --k,�''T am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be awaze that while homeowners who employ persons to do maiute=tce,conserctioa or repair work on a dwelling of not more than throe uads in which the homeowner resides or on the grounds appurtenant therdo=not generally oonndered to be employers under the woriteez compensation Act(GL152_s 1(5)),application by a homeowner for a licaae or permit may evidence the legal scat"of an employer under the Worker's Compensation Act I understand that a copy of this statement may be forwarded to the Departmml of Industrial Accidea&Offroe of InA anoe for the coverage verification and that failure to secure covemgo under section 25A of MGL 152 can lead to the imposition of mmmAl peaakics consisting of a fine of up to$1,500.00 andlor imprison of up to one year and civil penalties in the form of a stop Work order and a fare of sloo.00 a day against tne. S _day Of For departnee�nl u� y Permit Number Map# Lot# Si of Licensee/Permittee 10. Do any signs exist on the property? YES NO IF YES, describe size,type and location: Are there any proposed changes to or additions of signs intended for the property?YES NO IF YES, describe size,type and location: 11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This column to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &paved parking) # of Parking spaces # of Loading Docks Fill: (volume & location) 13 . Certification: I hereby certify that the informa on conta he erein is u and accurate to the best of my know dg DATE: APPLICANT's SIGNATU NOTE: suanoe f a z ing permit does not relieve an plioants burden to comply with all zonin requirements and obtain ail required permits from the Board of Health, Conservation Com ission, Department of Publio Workcs and other applioable permit granting authorities. FILE if 199 t File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE O P TALL INFORMATION 1. Name of pplicant: Addre I ph 2. � Owner of Property: 1 c Address: `yC Lr Telephone: L7�7� vC�l 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Street Address: e— Parcel Id: Zoning Map#—,// Parcel# �f District(s):- �--- (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property aA1Q1L 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): c i 7. Attached ans: Sket h Plan Site Plan Engineered/Surveyed Plans Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 8. Has a Special PermitNariance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document# 9. Does the site contain a brook,body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , date issued: (FORM CONTINUES ON OTHER SIDE) ►� ��FILE I APPLICANT/CO.NTACT PERSON: ,ADDR.ESSIPHON &Oer E: � Q �f� �(✓l G>/vim /' PROPERTY LOCATION: C MAP 117e PARCEL: P 73 ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE Fee Paid lRiffl(fing Permit Filled lit New Cnnqfriirtinn ArregsnryStruchire 7 d - ✓ f, 5 � THF OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: L/ Approved as presented based on information presented Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under:§ w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval-Bd of Health Well Water Potability-Bd Health !Permit from Conservation ornission �O Signature of Building Date NOTE:kmuanoa of as zoning permit does not relieva an applicant's burden to oomply with all zoning requirementp and obtain all required permits from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities. City of Northampton REQUIRED INSPECTIONS ti fl BUILDING DEPARTMENT 1. Footings and Walls • 2. Structural Components in Place* 3. Complete Building* Office of the Building Inspector NO. 473 Zoning Form No. 962333 Date 6/4/97 Fee$40.00 Check# 5847 Page, Parcel 275 ,Zone Ali Section 127 ❑ Yes © No BUI]LDINGPERMI F-I * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Bob Thibodo before Building Inspections has per mission to strip,install ply,& reshingle roof Inspection on Site—Foundations situated on 8 Cosmian Ave - Patricia ,lung Inspection of Plumbing—Rough provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish conform to the terms of the application on file in this office,and to the Gas Inspection provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough Maintenance and Inspection of Buildings in the City of Northampton. Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection of this card signed by the Plumbing,Wiring and Building Inspectors. Building Inspection—Finish Smoke Detectors(Fire Department) Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON PRE ISES Certificate of Occupancy Building Inspector